Structural Violence within Communities and Its Impact on the Wellbeing of Persons Living with HIV (PLWH)

Background and Purpose: Much research has focused on individual level factors that influence HIV health outcomes. Yet, a critical need exists to better understand community and neighborhood level determinants’ impact on health equity for persons living with HIV (PLWH).  To fill gaps in research and literature of these macro-level factors affecting PLWH, we interpreted data using the Structural Violence (SV) theory. This is the concept that there are, often invisible and intangible, structures in place, whether political, economic, legal, cultural, religious or social, that can inhibit individuals from reaching their full potential. Structural violence can have a widespread impact in neighborhoods and communities; however similar to other forms of community-based violence, we see its bearings heightened in minority groups. With the southern HIV/AIDS community being not only a minority community in itself, but also largely made up of minorities, exacerbated effects of structural violence may be linked to this health disparity, thereby negatively impacting health equity of PLWH.

Methods: In this community-based participatory research, in-depth interviews (n=40) were conducted with PLWH who previously established HIV medical care. On average, participants were 48-years-old (SD±8.9), Black (83%), and male (70%). Participants were recruited through word-of-mouth and community flyers. The face-to-face interviews included questions about participants’ lived experience in their communities, their HIV health, and any possible relationships between communities, neighborhoods and HIV health. Interviews were recorded, transcribed, coded, and triangulated through an iterative process during team meetings.

Results: Emerging themes implying a SV and health relationship include crime, drugs, financial insecurity, and disparate access to resources. Participants associated the presence of crime and drugs in communities with impacts on their emotional wellbeing and in some instances, on their physical health. Financial insecurity was identified as a barrier to achieving desired states of emotional wellbeing, physical safety and overall economic stability. Disparate access to resources, specifically transportation, food/grocery, and healthcare, should be highlighted as a notable product of SV, as these are all extensively documented in the literature as having the ability to impact individual health. These structures appear as engrained within communities and go unrecognized, both by health professionals and some PLWH, as disadvantageous to achieving optimal HIV health.

Conclusions and Implications: SV is ubiquitous, institutional, and can ultimately be influential of health outcomes for PLWH.  It is important for helping professionals to be able to recognize and understand SV as well as discuss how SV is intertwined with community-level factors.  Greater effort is necessary to identify community-level barriers, such as violence and lack of access to transportation, unequally experienced by PLWH and to recognize such factors in achieving optimal HIV health and overall health equity. A clearer understanding of this relationship can encourage advocacy by PLWH and policy makers to propose changes addressing the impact of structural violence in communities. Furthermore, lessons learned on how to recognize and mitigate this connection can better inform social work practice in minority communities.